In the days following a leaked plan from a U.S.-based public relations firm to derail proposed patent reforms in South Africa, those involved indicated that the plan, dubbed “genocidal” by South Africa Health Minister Aaron Motsoaledi, was the product of a misunderstanding. The U.S.-based firm, Public Affairs Engagement released a statement saying that when firm chairman James Glassman learned of proposed South Africa policy changes, he took it upon himself to contact the clients named in the proposal, PhRMA (Pharmaceutical Research and Manufacturers of America) and IPASA (Innovative Pharmaceutical Association South Africa), but the groups had not hired the company to design the “education campaign.” IPASA, in turn, put out a statement that still stands on its home page that it had rejected (underlined, on the site) the planned campaign. But then, a few days later came another leak, this time an email from IPASA intellectual property committee head, Michael Azrak, who also heads Merck’s East and Southern Africa offices — known as Merck, Sharp and Dohme, or MSD — saying the American firm had, in fact been selected after a “detailed process,” heartily endorsing the plan to further delay the South Africa policy that had already been six years in the making.

That, an update from South Africa’s Treatment Action Campaign explains, is why 500 activists showed up to picket MSD’s office last week. The day before activists held a demonstration outside an IPASA executive board meeting. TAC still wants to know if Azrak will be fired for endorsement of the campaign, and whether MSD continues to support the plan, which included a strategy of setting up a group that would appear to be led by a South African, but that would, in fact be directed by the U.S.-based firm. The plan also would not-so-subtly threaten financial consequences to South Africa if it adopts a policy tightening patent requirements. One of the purposes of the proposed patent reform is to improve and ensure accessibility of affordable medicines in a country where the numbers of people needing expensive second line antiretroviral therapy and treatment for drug resistant tuberculosis are among the highest in the world.

Two pharmaceutical companies have distanced themselves from the plan, and from the organization that selected it, since it was leaked, with Danish pharmaceutical company Novo Nordisk and Swiss drug maker Roche quitting IPASA in the week that followed public revelation of the plan, as recounted by articles in articles in South Africa’s Business Day. Norvo Nordisk told Business Day the company felt the proposed campaign “did not serve our or the industry’s interests,” and Roche told the publication that it did not support or approve the campaign.

In the meantime, both for activists, and the writers of this Economist piece, the plan to direct the public health and patent policies of South Africa as it grapples with deadly epidemics was reminiscent of the time pharmaceutical companies took the South African government — and Nelson Mandela — to court over the country’s effort to make HIV drugs affordable.

But for all the leaks, changed stories, resignations, and, one might assume, embarrassment on the part of the pharmaceutical associations linked to the latest plan, TAC and the Economist piece point out, the fate of South Africa’s patent policy remains undecided.